Mahzad Javid; Gholam Hossein Shahcheraghi
Abstract
Aim: Closed treatment using Ponseti casting technique is the standard management for clubfoot deformity. This study is investigating the efficacy of repeat use of Ponseti technique in late cases that had not achieved correction following previous attempts.
Method: A prospective study was conducted on ...
Read More
Aim: Closed treatment using Ponseti casting technique is the standard management for clubfoot deformity. This study is investigating the efficacy of repeat use of Ponseti technique in late cases that had not achieved correction following previous attempts.
Method: A prospective study was conducted on clubfeet cases of over 3 months of age who had not achieved correction with previous casting and were referred for surgery to our clinics. The Baseline and final Pirani scores were compared in a 4 .5- year average follow-up. The functional scores, recurrence rates and additional procedures required for correction were also documented.
Results:79 feet in 53 patients of 3 months to 9 years of age were studied. They had mean Pirani scores of 4.4 and had previously received 7.8 ± 2.5 castings and 9 Achilles tenotomies. An average of 4.3 ± 1.7(2–8) castings and 32 Achilles tendon lengthening were needed to achieve complete correction in 77 feet (98%). Relapse of deformity was seen in 42 (53%) feet, which dropped the correction rate in the final follow-up to 89%. However, the functional score at the end , was good or excellent in 93% of the cases.
Discussion: Accurate re-use of Ponseti technique in cases of previously- failed clubfoot casting has high success rate, even in late referrals.
Level of Clinical Evidence : Level 4
Gholam Hossain Shahcheraghi, MD, FRCSC; Mahzad Javid, MD
Abstract
Background: The congenital absence of the tibia is a rare disease, and an orthopaedic surgeon may not encounter such cases during the course of his/her career. This is the largest report to date of the management of such cases by a single surgeon. The foot and leg were persevered in the majority of the ...
Read More
Background: The congenital absence of the tibia is a rare disease, and an orthopaedic surgeon may not encounter such cases during the course of his/her career. This is the largest report to date of the management of such cases by a single surgeon. The foot and leg were persevered in the majority of the cases, and a functional evaluation system was used to report outcomes.
Methods: Thirty-six patients (19 girls, 17 boys) with 48 tibial deficient limbs were evaluated clinically and radiographically. The mean age of patients was 12 years old. The patients or their parents filled out the Pediatric Quality of Life and the parents’ satisfaction forms. The surgical interventions performed, and their effects on school attendance and the shoe type they wore were documented.
Results: The mean time of follow-up was 9 years. The 48 limbs included 14 type I, 16 type II, 11 type IV, and 7 unclassified by using the Jones classification; and 6 type I, 11 type II, 16 type III, 1 type IV, and 14 type VII by using the Weber classification. Primary amputation was performed in 10 limbs (8 patients) and limb preservation surgery on 38 legs (28 patients). Tibiofibular synostosis, centralization of the ankle, and Ilizarov lengthening were the most common procedures. Non::union:: of tibiofibular synostosis (2 cases) and knee stiffness (6 cases) were the main complications. Among the reconstructed limbs, 12 were in regular and 18 in modified shoes. The Pediatric Quality of Life of 68 points in the reconstructed group was a significant achievement, and it was also better than the score of patients who had undergone amputation.
Conclusions: Reconstruction of tibial hemimelia with foot preservation provides good functional outcome in the majority of cases.
Gholam Hossain Shahcheraghi, MD, FRCS(C); Mahzad Javid, MD; Mohammad Arasteh, MD xArasteh, MD
Abstract
Background: Thromboembolic disease (TED) after knee arthroplasty occurs infrequently in Iran. The aim of this study was to examine the incidence of TED in patients with osteoarthritis undergoing knee replacement in Southern Iran while on prophylaxis.Methods: In a prospective case series study from ...
Read More
Background: Thromboembolic disease (TED) after knee arthroplasty occurs infrequently in Iran. The aim of this study was to examine the incidence of TED in patients with osteoarthritis undergoing knee replacement in Southern Iran while on prophylaxis.Methods: In a prospective case series study from January to December 2012, 100 consecutive total knee arthroplasty (TKA) candidates were evaluated for TED by clinical evaluation and doppler sonography preoperatively and 2 months postoperatively and by clinical evaluation one year after surgery. The patients in this study randomly received either warfarin or enoxaparin prophylactically.Results: A total of 77 women and 23 men with mean age of 67 years (52-82 years) entered the study. The average hemoglobin drop of 2.7 g with warfarin and 3.3 with enoxaparin was observed. No case of TED, pulmonary embolus (PE), major bleeding, post-thrombotic syndrome, or hemarthrosis was observed.Conclusions: No clinically significant DVT was found using either enoxaparin or warfarin prophylaxis after TKA in Southern Iran. Relatively excessive postoperative bleeding was observed, particularly with enoxaparin.The article is published online in Journal of Orthopaedics, 01/2014: 12(2):86-91 and is available online at www.sciencedirect.comjournal homepage: www.elsevier.com/locate/jorCopyright 2014 by Professor P K Surendran Memorial Education Foundation. Publishing Services by Reed Elsevier India Pvt. Ltd. All rights reserved.
Mahzad Javid, MD; Gholamhossain Shahcheraghi, MD, FRCS (C); Farivar Lahiji,MD; Azis Ahmadi, MD
Abstract
Background: Doing surgery on wrong location, or wrong person, or doing a different surgery by mistake, are all horrible, though not infrequent happenings. This is a report on an attempt to determine the incidence of "wrong-site” surgery among the Iranian Orthopaedic Surgeons.Method: A one-page questionnaire, ...
Read More
Background: Doing surgery on wrong location, or wrong person, or doing a different surgery by mistake, are all horrible, though not infrequent happenings. This is a report on an attempt to determine the incidence of "wrong-site” surgery among the Iranian Orthopaedic Surgeons.Method: A one-page questionnaire, regarding personal experience or having witnessed or heard about "wrong-site" surgery during the last 2 years, was mailed to the active members of Iranian Orthopaedic Association (IOA). All the members were also contacted by phone to confirm the receipt of the questionnaires and request an earlier return of the forms. The returned forms and the telephone responses were analyzed.Results: From the 736 questionnaires sent out to the IOA members, 54 (5.7%) written response was received back. 368 (50%) members denied having personally faced or heard of any "wrong site" surgery. 313 IOA members (%42.5) did not participate, and gave no answer – nor on phone, neither by writing. Among the 54 returned questionnaires, 29 members had encountered or were aware of 40 cases of "wrong", surgery which included 32 mistakes in the side of surgery and 8 cases of wrong limb surgery.Conclusions: The response rate to questions regarding "wrong" surgery is very low in IOA members. Adherence to a strict protocole in avoiding wrong-site or wrong limb surgery may decrease the number of mistakes in any busy operating room.
Mahzad Javid; John H Wedge
Abstract
Background: Treatment of Legg–Calvé-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate, femoral or combined osteotomies are generally provide more coverage of the femoral head by the acetabulum with the objective of achieving a more spherical ...
Read More
Background: Treatment of Legg–Calvé-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate, femoral or combined osteotomies are generally provide more coverage of the femoral head by the acetabulum with the objective of achieving a more spherical head and congruent joint. The purpose of the study was to evaluate the radiographic outcomes of simultaneous femoral and pelvic osteotomies. Methods : We reviewed the radiographic changes of 20 patients with Legg–Calvé–Perthes disease with a disease onset of over eight years of age who had undergone combined femoral and Salter innominate osteotomies. The hips in these 20 patients comprised 11 lateral pillar (LP) groups B, 7 B/C, and 2 C. The patients were evaluated with a mean follow-up of five years and five months using the Stulberg radiographic assessment. Results: Among those 20 hips, six became Stulberg II (SII), nine SIII, and five SIV. From the 11 LPB hips, five became SII, four SIII, and two SIV. The seven LPB/C turned out to be SII in one case, SIII in four, and SIV in two. One of the two LPC hips became SIII and one SIV. The three female patients had one LPB, one LPB/ C, and one LPC hip, and surgery resulted in SIII hips in all. Conclusions: Combined osteotomies in older children with a higher LP grouping can marginally improve the radiographic outcome in comparison with the natural history in LPB/C and LPC cases by converting a number of poor to fair results.
Mahzad Javid, MD; Gholam Hossain Shahcheraghi, MD, FRCS(C)
Abstract
Background: Shoulder deformity and contracture is a common finding after brachial plexus birth palsy even in those who have had good recovery of nerve function or have had micro surgical nerve repair at infancy. We would like to report our results with the reconstructive shoulder surgery in a group of ...
Read More
Background: Shoulder deformity and contracture is a common finding after brachial plexus birth palsy even in those who have had good recovery of nerve function or have had micro surgical nerve repair at infancy. We would like to report our results with the reconstructive shoulder surgery in a group of older children.Methods: Shoulder contracture from brachial plexus birth palsy was surgically released in 24 older children, with simultaneous transfer of the latissimus dorsi and teres major tendons to the posterolateral humerus or rotator cuff. The mean age at surgery was 8 years 11 months. The children were evaluated at a mean follow-up time of 6 years 8 months by the Modified American Shoulder and Elbow Surgeons Form and Shoulder Pain and Disability Index standardized shoulder assessment forms, a questionnaire assessing activities of daily living, and parent and patient satisfaction scales.Results: The fixed internal rotation deformity of 30º±12º improved to 72.5º±27º of external rotation. Improvements of 65º±26º and 47º±33º were seen in abduction and forward elevation, respectively, all without preoperative casting or manipulation. Increased external rotation had a more positive correlation with a higher functional score than abduction. Patients with lower preoperative functional scores had more rotational gain and higher functional scores after surgery. Those aged over 9 years had a functional gain similar to that of the younger children.Conclusion: Simultaneous release of contracted shoulder and transfer of latissimus dorsi and teres major tendons in brachial plexus birth paralysis is effective, and rewarding even in older children who have had late referral, and might have already developed glenoid dysplasia.
Mahzad Javid, MD; Gholamhossain Shahcheraghi, MD, FRCS (C); Farivar A Lahiji, MD; Aziz Ahmadi, MD; Afshin Farhadi, MD; Gholam Ali Akasheh, MD
Abstract
Background: To find the patterns and common mechanisms of motor-vehicle related pediatric trauma in a metropolitan city (Tehran-Iran), to guide the health planners of the city in proper planning and resource application and distribution.Methods: A pilot study was started in three major pediatric-trauma ...
Read More
Background: To find the patterns and common mechanisms of motor-vehicle related pediatric trauma in a metropolitan city (Tehran-Iran), to guide the health planners of the city in proper planning and resource application and distribution.Methods: A pilot study was started in three major pediatric-trauma referral centers in Tehran by the Iranian Orthopaedic Association. All the cases below age 14 who visited the emergency department of those three hospitals, with body trauma resulting from a vehicle-related accident were studied. Cases were collected on a 24-hours basis in one month of each four seasons of the last year. The data collection was done by contracted physicians with the use of a detailed questionnaire.Results: From a total of 318 children that visited the emergency departments because of motor–vehicle related accident, 287 patients had trauma to various parts of the body (215 male 72 females), 151 cases had only musculoskeletal trauma and 31 others had sustained no significant injury of any kind. Multiple trauma was seen in 33.6% of the cases.52.8% of accidents happened in spring & summer, 21/7% in autumn, and 25/5% in winter season. The place of accidents were usually on the streets (70%), followed by small allies (17/5%), then major roads (12/5%). 65% of the accidents had happened at night and 35% during the day. The injuries were from motorcycles hitting pedestrians in 33.7% and, car–pedestrian accidents in 31.9%. The musculoskeletal injuries included fracture of tibia and fibula (62 cases), femoral fracture (25 cases), forearm (18 cases) and humerus (11 cases) in order of frequency. 24% of patients were transferred by ambulance and the rest by their family members or by- standing people. Conclusions: Children become disabled far too frequently in the city, from lack of proper training, proper enforcement of traffic rules by the children and the drivers. An appropriate measure of safety in the crowded metropolitan city of Tehran is essential, and this report can be a guide for the other major cities of the third world.
